Final Review - 2nd 1/2 of semester

Question 1

Does adrenergic activity increase, decrease, or stay the same as people age?

Answer 1

it decreases

Question 2

Do autonomic responses increase, decline, or stay the same?

Answer 2

They decline –> autonomic dysfunction

Question 3

2 CV responses that are altered in geriatric pos d/t blunted B-receptor response

Answer 3

• decreased max HR

- decreased peak EF

Question 4

What resp factors increase in geriatric pts?

Answer 4

Increase:

• Residual volume
• Closing capacity/closing volume
• FRC
• Dead space
• Vd/Vt ratio

Question 5

What resp factors decrease in geriatric pts?

Answer 5

Decrease:

• Alv surface area
• Vital capacity (decreases 25 mL/yr starting at age 20)
• TLC

Question 6

Does cerebral blood flow change in the geriatric population?

Answer 6

Yes, it decreases, along w brain mass

Question 7

Do neurotransmitters change in the geriatric population?

Answer 7

Yes, they decrease (dopamine), and their receptors are decreased as well

Question 8

Do dosages for local and general anesthetics change in the geriatric populations?

Answer 8

Yes, both are decreased

Question 9

How to epidural and spinal durations change in the elderly?

Answer 9

Spinals - increased duration

Epidurals - decreased duration

Question 10

Do elderly pos have increased or decreased sensitivity to anticholinergics like scopolamine and atropine?

Answer 10

markedly increased sensitivity

Question 11

How does body fat and muscle mass change in the geriatric population?

Answer 11

Body fat increases - more in women

muscle mass decreases - more in men

Question 12

Is total body water increased or decreased in the elderly?

Answer 12

decreased

Question 13

Lipid soluble vs water soluble drug effects in elderly

Answer 13

Water soluble - decreased volume of water –> increased plasma concentrations –> greater effect

Fat soluble - increased volume of distribution –> lower plasma concentrations –> decreased effect

Question 14

T/F: In the elderly, myocardial depressant effects of anesthetics are exaggerated while the tachycardia response is decreased.

Answer 14

True

Question 15

3 reasons the elderly take longer to wake up from anesthesia

Answer 15

• increased body fat
• decreased hepatic
• decreased pulm gas exchange

Question 16

5 criteria for c/spine injury

Answer 16

• neck pain
• severe distracting pain
• any neurological s/s
• intoxication
• loss of consciousness at scene

Question 17

What acid/base imbalance to trauma its experience after massive transfusions?

Answer 17

metabolic alkalosis

also remember hyperK w massive transfusions

Question 18

If transfusion rate exceeds ___ unit(s) q _____ min, you can see cardiac depression caused by _______

Answer 18

1 Unit
5 min
hypocalcemia

Question 19

How can a hemolytic transfusion reaction be recognized in an anesthetized pt?

Answer 19

• increased temp
• tachycardia
• HoTN
• hemoglobinuria
• oozing at field

Question 20

Common cause of bleeding after massive transfusions

Answer 20

dictional thrombocytopenia

Question 21

half life of crystalloids and colloids

Answer 21

crystalloids - 20-30 min

colloids - 3-6 hrs

Question 22

What crystalloid is more likely to cause hyperK acidosis and can aggravate cerebral edema when given in large volumes? LR or NS

Answer 22

LR

cerebral edema - it is slightly hypotonic

Question 23

Why do hypovolemic pos need less anesthetic?

Answer 23

alv conc’n is increased in shock pos r/t decrease in CO and increased ventilation

IV anes - smaller intravasc volume –> IV anesthetics are exaggerated

Question 24

What is cushings triad and what does it indicate?

Answer 24

• HTN
• Bradycardia
• Resp disturbances
• late signs of brain herniation

Question 25

What is Beck’s Triad? What does it indicate?

Answer 25

• Neck vein distention
• HoTN
• Muffled heart tones
• cardiac tamponade - NO PROPOFOL!!!!!! - use etomiade =)

Question 26

An astute anesthetist should watch for ______ during a pericardialcentesis to indicate when the needle has gone too far into myocardial tissues

Answer 26

EKG changes

Question 27

What can an anesthetist expect to occur on incision when an abd trauma pt undergoes an ex lap?

Answer 27

HoTN

Question 28

Fat embolism labs

Answer 28

• elevated serum lipase
• fat in urine
• thrombocytopenia

Question 29

4 ways an anesthetist can control intracranial HTN

Answer 29

• fluid restrictions
• diuretics (mannitol)
• Hypocapnia (CO2 26-30)
• DON’T GIVE KETAMINE

Question 30

high cord injury –> spinal shock –> loss of sympathetic tone –> ??

Answer 30

• HoTN
• Warm to touch
• bradycardia
• areflexia
• GI atony

Question 31

Is succs ok for an autonomic hyperreflexia pt?

Answer 31

It sure is =)

Question 32

Tx for simple vs tension PTX

Answer 32

Simple - chest tube 4th or 5th intercostal space (air is in the parietal and visceral pleura; lung collapses)

Tension - 14# needle at 2nd intercostal space midclavicular line then chest tube like for a simple (air is in pleural space, is trapped, and increases w insp but doesn’t escape w exp)

Question 33

You are in the OR and the alarms on the anesthesia machine are going off constantly. What is going on and what do you need?

Answer 33

ARDS .: poor lung compliance

Need high airway pressures/a better vent w higher gas flows